Outcome of focal treatment to residual retinoblastoma after chemotherapy (Experience with Focal Treatment of Retinoblastoma)

We report a prospective case series on the anatomical, and functional outcomes, and complications of focal treatment of retinoblastoma to residual tumors in patients who had already received chemotherapy. We examined the patients of retinoblastoma under general anaesthesia with Ret Cam II. Patients with lesions from Group 1 to Group 5 of Reese Ellsworth classification at presentation. They were first given chemotherapy according to VEC (Vincristine, Etoposide and Carboplatin) protocol and then focal treatment. Solid State Green laser photocoagulation and/or cryotherapy were applied to the lesions with help of indirect ophthalmoscope. Thirty one eyes of 26 children were treated. The mean age at presentation was 35.5 ± 6.4 (median = 24, IQR = 36) months. Fourteen (57.7%) were male and 12 (42.3%) were female. Twenty three (88.5%) children had bilateral retinoblastoma and 3 (11.5%) had unilateral involvement. Complete regression was achieved in 25 (80.6%) eyes. Only 6 (19.4%) eyes had to be enucleated. Final mean LogMAR visual acuity after treatment was0.6 ± 0.64. Transient Corneal oedema was the most commonly observed adverse effect seen immediately after laser photocoagulation in 12 (38.7%) eyes. Focal treatment is a good and effective adjuvant to systemic treatment and ophthalmologists should be aware of this modality of treatment and competent enough to use these modalities appropriately to improve the outcome of RB patients in our population.

Role of the Penrose drain in the management of VLBW infants with perforated necrotising enterocolitis

We studied the effectiveness of the Penrose drain in very low birth weight infants with BW < 1500g with perforated necrotizing Enterocolitis. We reviewed the infants with perforated NEC over the 9 years between 1995-2004. The inclusive criteria was free intraperitoneal air in VLBW infants < 1500g. A total 22 infants were studied. Gestational age ranged from 23 to 33 weeks. Perforated NEC was diagnosed on PFA. In all infants a Penrose drain was inserted in either the right or left lower abdominal quadrants. Most of the infants fell in the BW range 800g to 980g with median age of 16 days. The incidence of Perforated NEC was very high in females (81.8%) as compared to males (18.2%). A Penrose drain was inserted on the same day when the pneumoperitoneum was diagnosed. A total of 22 infants had a Penrose drain inserted. Two (9%) showed improvement, 20(91%) were taken to theatre for laparotomy. Thirteen (59%) had an ileostomy performed. Seven (31.8%) had extensive bowel necrosis and subsequently died. A total 15(68.2%) out of 22 survived with initial management of Penrose drain insertion and subsequent laparotomy. Penrose drain insertion is an effective first line treatment in the pre-term infant BW < 1500g, with perforated NEC.

Laparoscopic appendectomy versus open appendectomy in children

This study compares the benefits, advantages and complications of laparoscopic Appendicectomy (LA) versus Open Appendectomy (OA) in children's in Dublin Ireland. Total 200 patients were studied. Hundred of LA and 100 for OA. Out of 100 LA 58 were male, 42 were female aged between 4-15 yr. and out of 100 OA 58 were male, 42 were female aged between 4-14 yr. The mean operative time of LA was 35.8 minutes and the Anaesthetic time was 46.6 minutes. Patients having LA had less post-op pain with early start of feed at 16.7 hrs, and had significantly less post-op hospital stay of 1.6 days. Post op complications rate was 3%. The patient started the normal life activities at 10.8th post op day. Wound infection rate was 3% with Re-admission rate of 2%. The mean operative time of OA was 45.66 minutes and the Anaesthetic time was 56.75 minutes. Patients having OA had post-op pain hospital stay of 2.55 days with start of feed at 24.7 hrs. Post op complications rate was 2%. The patient started the normal life activities at 15.78th post op day. Wound infection rate was 3% with Re-admission rate of 1%. Laparoscopic appendectomy is safe alternative to conventional open appendectomy, leading to early ambulation, decreased hospital stay, and better exploration of abdominal cavity.